End-of-life care

Evidence lacking but RBC transfusions may provide subjective benefit: study


A new study has been unable to establish any scientific benefits in providing red blood cell transfusions to palliative care patients, but researchers have stopped short of advising physicians to abandon it as a treatment option.

The retrospective study, published in the Journal of Palliative Care, is the precursor to a larger prospective multi-site study expected to be out later this year.

Lead author Dr Timothy To, a consultant with South Adelaide Palliative Services and researcher at Flinders University, said red blood cell (RBC) transfusions are commonly prescribed for palliative care patients for symptoms such as fatigue and breathlessness.

And while there have been varying studies on the treatment over time, most of these have been small and have not fully established whether there is enough evidence to demonstrate benefits or harm.

“There is a lot of grey area with this and it is challenging because it is so subjective,” he told the limbic. “There are certainly people who feel like they get a benefit and I think there is certainly are group who get a psychological benefit.”

The consecutive cohort study retrospectively reviewed transfusions administered during a PCU admission. Haemoglobin levels, physical function, and symptom rating for breathing and fatigue (Symptom Assessment Scale) were assessed before transfusion, and at days 2 and 7.”

Interestingly, both clinicians and patients were not far away from each other when it came to benefits – 89% of transfusions were thought by clinicians “to be of subjective benefit”, while 94% of patients reported “symptomatic improvement”.

“However, overall, there was little change in scale-based measures of physical function or symptoms, with response rates <25% in all scales,” the researchers wrote. “No predictors of response were found considering pretransfusion haemoglobin, haemoglobin increment, Australia-modified Karnofsky Performance Status, or discharge status. Deterioration after transfusion was prevalent.”

Dr To said the key message for clinicians was that while RBC transfusion in palliative care had poor objective-scale measures, the majority of patients who received a transfusion experienced subjective benefit. And while this was challenging from an evaluation point of view, low risk of harm meant it was worth considering as a potential treatment.

“It’s probably about making a case-by-case assessment,” he said. “A try it and see approach may be a good approach.”

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